<!DOCTYPE html PUBLIC "-//W3C//DTD XHTML 1.0 Transitional//EN" "http://www.w3.org/TR/xhtml1/DTD/xhtml1-transitional.dtd">
<html xmlns="http://www.w3.org/1999/xhtml">
<head>
<meta http-equiv="Content-Type" content="text/html; charset=utf-8" />
<title>Untitled Document</title>
<style type="text/css">
<!--
.style1 {color: #000099}
.customer {
	font-weight: 400;
}
-->
</style>
</head>

<body>
<fieldset width="900">
<legend> <span class="style1">New Customer</span></legend>
  <table width="675" height="237" border="0">

    <tr>
      <td width="153"><div align="right">First Name</div></td>
      <td width="235"><label>
        <input type="text" name="textfield13" id="textfield13" />
      </label></td>
      <td width="69"><div align="right">Last Name</div></td>
      <td width="144"><input type="text" name="textfield13" id="textfield14" /></td>
    </tr>
    <tr>
      <td><div align="right">Company Name</div></td>
      <td colspan="3"><input type="text" width="400" name="textfield" id="textfield" /></td>
    </tr>
    <tr>
      <td rowspan="3"><div align="right">Address</div></td>
      <td><input type="text" name="textfield2" id="textfield2" /></td>
      <td colspan="2"><p>&nbsp;</p>      </td>
    </tr>
    <tr>
      <td><input type="text" name="textfield3" id="textfield3" /></td>
      <td><div align="right">Email</div></td>
      <td><input type="text" name="textfield13" id="textfield14" /></td>
    </tr>
    <tr>
      <td>
        <label>
          <select name="select" id="select">
            <option>Suburb1</option>
            <option>Suburb2</option>
            <option>Suburb3</option>
          </select>
          <input type="text" name="textfield4" id="textfield6" />
      </label></td>
      <td><div align="right">Password</div></td>
      <td><input type="text" name="textfield13" id="textfield14" /></td>
    </tr>
    <tr>
      <td><div align="right">Email</div></td>
      <td colspan="3"><input type="text" width="400" name="textfield7" id="textfield7" /></td>
    </tr>
    <tr>
      <td><div align="right">Home phone</div></td>
      <td><input type="text" name="textfield6" id="textfield26" /></td>
      <td><div align="right">Work phone</div></td>
      <td><input type="text" name="textfield6" id="textfield27" /></td>
    </tr>
    <tr>
      <td><div align="right">Mobile</div></td>
      <td><input type="text" name="textfield6" id="textfield12" /></td>
      <td><div align="right">Fax</div></td>
      <td><input type="text" name="textfield6" id="textfield25" /></td>
    </tr>
    <tr>
      <td><div align="right">PreferredContactMethod</div></td>
      <td colspan="3"><select name="select2" id="select2">
        <option>Mobile</option>
        <option>Email</option>
        <option>Home</option>
        <option>Work</option>
            </select></td>
    </tr>
  </table>
  </fieldset>
</body>
</html>
